Broken Windows

Broken window at Ellis Island hospital

It irks me beyond measure that my eyes are aging to the point that to read posts from the WordPress app on my phone I now require glasses, that to look at certain skin lesions in clinic I need to run grab the red framed readers that I *affectionately* call my old-lady glasses. Adjusting to this new reality is taking some time. I still find myself stubbornly squinting at the screen as if denial will make it all go away… 

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Thursday Thoughts From the Throne

Clock feature in a small park in NYC

Is the day over? No?

Phew!

Made it. 

My colon has been awfully out of whack this week. So has my running schedule, come to think of it…

So, most of the time I try to avoid talking politics and religion with my patients and my friends. There are only a few trusted people I feel I can have a rational conversation with. Today, though, I ran across one of those people who was trying to convince me that my theology was misguided and that abortion was wrong in all circumstances. Even in the case of an 11 year old girl who was molested by her uncle.

Don’t get me wrong, I like this guy. He is a good man, even if we fundamentally disagree. However, he made a comment about prayer in school that got my dander up. Specifically he said that Christian prayers only should open every school day and that more of it probably would have prevented the Las Vegas shooter from killing all of those people.

Um. No.

I am going to skip the theology question and the abortion issue and hit on that school prayer statement.

Being prayed at is not the thing that prevents hurting people from lashing out. Love does. Good parents who try to do right by their kids and their spouses, fellow human beings who show kindness…. these are the things that prevent damaged people. 

Loving people who need it is awfully darn hard. 

I am not saying don’t pray. Go ahead and pray. I pray. Prayer is powerful. Prayer can help you love, help you find kindness when you don’t think there is any left inside of you. Here’s the thing, though: Don’t you ever think for one minute that your prayer means you have done your duty and your responsibility to other people stops there. No. You have to physically reach outside of yourself and help those around you or you are just saying empty words. 

I used to be that person, the one for whom the world was black and white. No amount of arguing or reasoning could change my mind. I was so full of anger back then. Why doesn’t everyone see the logic that I see? Life had to show me the all of the other shades of gray and the myriad of vibrant colors that make up this world. It had to show me that I am not as smart as I thought I was. 

Life is still teaching me.

Kind of makes me wonder what I will think of this post in ten years…

Flight

Birds in flight inside the American Museum of Natural History in NYC

“I asked her, ‘Aren’t you afraid?’ She touched my face and smiled. ‘No. Not at all.’

‘How can you not have fear?’

‘Because I have you. You are the strongest man I know.’”

He stopped for a moment, emotion stealing his words.

“The tumor doubled in size in 7 days. I don’t know what to do, how to help her… how to let her go.”

I have had so many conversations like this, two just this week. I always marvel at how the afflicted can be so strong, so full of peace and resolve even as those around them are falling to pieces. 

What sets them apart? 

There have been times in my life where I have been so depressed I have prayed to die. 

Please, God, take me in any way that you see fit…

But I was never peaceful about it.

I have fear. So much fear.

Fear of suffering. Fear of the unknown. Fear of the loss of control. Fear of being known for who I really am.

Who am I?

What sets them apart?

How do you come to terms with dying? 

“She says she will see me later, that it isn’t really goodbye.”

Faith.

Is it possible that it is simply faith in love… love which takes many forms… that gives us peace?

Biometrified

Stubborn
The tall, slim receptionist took my information and motioned for me to have a seat. “He’ll be with you in a moment,” she murmured sweetly. 

I settled myself into a nearby chair and pulled out my smart phone. Time to catch up on some blog reading. 

At one point I looked up from a post and saw the woman take a bite of a candy bar. She turned to a coworker standing next to her and whispered loudly, “My biometric screening appointment is in two weeks. I have to start my liquid diet tomorrow. I need that discount!” Her coworker mumbled something inaudibe in commiseration as she munched a largish chocolate chip cookie* then said, “There is no way I will ever have the right waist circumference. I just don’t even bother to try anymore.”

Is a liquid diet healthy when the rest of the year you eat like crap and don’t exercise? Apparently her employer thinks so. 

Many employers appear to think so.

I have serious issues with companies who discount insurance plans based on whether or not an employee falls within an assigned range on their blood sugar, cholesterol, BMI, and blood pressure. Does it really improve health? I am skeptical. 

High cholesterol effects, blood pressure issues, diabetes complications… generally are not going to cause an increase in health expenditures until much later, presumably when patients are retired or no longer employed. So why would their employer care now? Between the two of us, it smacks of a way to force employees to pay for more of their own insurance costs. I wonder how much that saves corporate America? 

So sorry, that’ll be an extra $600 in our pocket. Better luck next time!

It isn’t just that I hate taking the time to fill out the forms for patients, though they are tedious. It feels like a terrible invasion of privacy. Why does an employer need to know if your blood sugar is under 100? What difference does a 102 make to whether or not you can do your job? What does a 102 mean for absenteeism, productivity, customer satisfaction, or anything else they want to measure?

“My employer seems to really care about my health. They gave me a free pedometer!”

“Has that made you walk more?”

“Well, no…”

Each program, it seems, has its own unique set of thresholds… some want a blood pressure under 140/90. Some want a blood pressure of 130/70 or less. Some want a BMI of 25 or less. Others want a BMI of under 30 or even 35. Some don’t care about where you fall, they just want you to submit the numbers. Others want you to enroll in an online health class or two. I have never had a patient come in, however, and tell me that they saw the light after one of those classes and have decided to change their ways.

Many companies require employees to go to a screening at HR rather than heading to their own physician. They have a lay person interpreting those results and giving suspect advice to my patients that can take several office visits to undo. Worse, many patients then believe they then don’t need to do a physical with their primary care physician. I lose my one opportunity each year to catch patients up on their PAPs and mammos and colonoscopies, my one opportunity to screen for depression and to talk about healthy lifestyle.

Here’s another thing, though. There are people who have “high” cholesterol who are in great physical condition otherwise and yet, because their LDL is above a certain point, have to pay considerably more for their health insurance. What difference does an LDL of 148 make when the HDL is terrific and there are no other risk factors for cardiovascular disease? I wouldn’t be putting a healthy 24 year old patient on a statin drug because their LDL is 130 simply to get them below 120 for a better insurance rate. And then there is the issue of diabetes. It is a false perception that diabetes is only about diet and lifestyle. It is a genetic predisposition. Is it fair to punish you because your diabetic parents decided to have children? Ultimately it is a form of genetic profiling and I am surprised no one has made a bigger issue of this. 

We have a version of this for employees of the healthcare system I work for. There are tons of invasive questions about my daily habits and diet and exercise routines that I am required to answer and then I have to submit my screening numbers and measurements electronically to HR in order to receive the discount. We don’t have to meet certain criteria on those numbers… yet. I choose to opt out. I have the financial luxury of being able to do that, paying more for my health insurance. Many people, though, don’t have that ability.

So what are your thoughts?

*Please note, I am not saying here that chocolate OR cookies are inherently evil. In fact, they can be part of a healthy diet.

The Overseers

Through a window at the American Museum of Natural History in NYC

I see your drones flying overhead,
Your truck driving by.
I know you are watching me,
Following my every move… 
Silently waiting 
For the proper time to strike. 
You know my internet searches,
The names of my kids. 
You know my habits 
And my darkest faults. 
Some days you know my secret wishes 
Before I can even get the chance 
To wish them. 
Always there, behind the scenes 
Your satellites measuring my level 
Of devotion. 
Well placed hints, strategic glimpses, 
All forms of intimidation
Meant to remind me that I am yours 
Entirely,
Forever subject
To your every whim.

*****************************************

If you want to see something fun, zoom in on the bottom left of the photo.

Thursday Thoughts From The Throne #4


Today’s’ thought is brought to you by my upstairs bathroom….

I am a huge fan of grandparents. I really love celebrating Grandparents Day. I do NOT, however, appreciate schools celebrating Grandparents Day by inviting everyone’s grandparents to come for some function or another. 

Here’s why:

  1. They are invariably disorganized.
  2. There are always a fair number of kids whose grandparents are dead or live too far away to come.

My kids are blessed that they have a grandmother who comes to these things but I have each year encountered the kids who don’t, who are stashed in a back room looking forlorn and left out. It tugs at my heart. 

This year my kids were supposed to write letters and make artwork for their grandparents. Earlier this year their PawPaw died. My son’s letter read like this:

Dear grandfather, I wish I could still speak with you. Even if I will not see you, I will always keep you in my heart.

He gave it to his Granny instead. 

It was good on some level, helping the kids work through their grief but I sure do wish the exchange could have been done privately instead of in front of the whole assembly, putting their grief and their grandmother’s grief on display. 

And that is all my butt has time for today!

The Twelfth 

World Trade Center

“Mommy, why are there so many police everywhere?”

I looked around. She was right. They stood on every street corner it seemed, decked out in bulky bullet proof vests. New York City, more than any other city in the world that I have visited, possesses a very visible police force. No longer simply protecting us from each other, they stood ready to protect us from them.

Did it make me feel safer? 

Yes. Yes it did.

I grabbed my daughter’s hand as we crossed the street with the crowd of other people. The Empire State Building rose up in the distance. 

“Are you going to take your kids to the 9/11 museum?”

They are six and seven.

“No. They aren’t ready for that yet.”

I’m not ready for that yet.

I dropped my purse and camera into a bin and wiggled out of my jacket, sending it and my ball cap through the scanner then stepped through the metal detector. The security guard nodded silently. We were free to move on to the next staging area. 

“Mom, why is it that everywhere we go here is like the airport?” my son asked.

In truth this was the forth scanner we had walked through on this trip. Long lines made longer by strict security. Stress. My kids felt it. So did I.

“Some years ago there was an attack on two tall buildings here in New York. They collapsed and thousands of people died. There are people who hate Americans and want to hurt them so the police and all of the security measures are trying to prevent something from happening like that again.”

Watching the towers collapse over and over again on the news feed at the clinic between patients, the world shifted. It wasn’t until the next day, as the dust was settling, that it became apparent just how much it had shifted. 

My kids seemed to take in the information and I braced myself for more questions, for fear, or even tears from my daughter, but there was nothing. 

Nothing.

This is their world. They don’t know what it was like before 9/11, a world where simply being American carried with it a certain degree of power and respect. They didn’t feel that shift. They will only know a September 12th world, a world where they are targets. 

Pumped Up

IMG_1233

“Well, you see… I was benching 300 pounds and felt something give in my right shoulder. It’s been hurting ever since.”

“How long ago was this?”

“Um.” He searched his memory. “Three months ago? Maybe longer.” He shrugged, then winced.

“Why the hell are you benching 300 pounds?” 

Did he really do that? Or was he maybe exaggerating just a smidge?

I mashed around on his shoulder, bringing on another wince, and walked him through some range of motion exercises to evaluate the joint further. This was his sixth injury from lifting in past 24 months. I had already told him he needed to back off a bit.

“I need to gain weight. I need more muscle.” 

He came from a long line of average height, thinly built people. He had already put on 25 pounds of muscle since the last time I saw him. Much more was going to be impossible.

“You are fighting genetics, you know. You are not going to be able to bulk up more than you already have without doing dangerous stuff.”

He look back at me, clearly horrified. “Oh, no, I’d never do that, Doc! But I’ve at least got to make my chest look good. That’s what the ladies want.” He puffed up his chest for effect.

“I’m a lady. That’s not what I want. I don’t think that is what most women want.”

He stared at me with a single eyebrow cocked up in disbelief standing out on his fresh-out-of-college face.

“So, what do women want, then?”

“Security. Respect. Love. Not necessarily in that order.”

He rolled his eyes and laughed. 

Had no one said this to him before?

“Sure, Doc….” His reply held a hint of sarcasm.

“Don’t get me wrong. I appreciate a man who takes care of himself, who stays fit. That in itself is an act of love, but having impeccable pecs is really not necessary. Pushing the envelope is really not necessary. A guy who says, ‘You need to carry the groceries in yourself, hon, because I can’t lift the sacks with my jacked up shoulders and I can’t walk with this bum knee,’ isn’t really sexy if he did it to himself.”

There was silence as I ordered an MRI in the computer. Thousands of dollars already spent treating his injuries, what was a few more?

Then he laughed.

“I guess you’re right, Doc.”

Damn right, I’m right.

“Just take it easy on your body. It has to last you the rest of your life…”

*****************************************

I have had several conversations like this over the past year. I talk a lot about how body image issues affect women but there is a ton of pressure for men, for boys even, and it is getting worse. A distortion and misrepresentation of what is possible and what is desired is being perpetuated by media, by people selling lies. 

Fight back, I say. 

Fight back.